Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) technique and analgesic efficacy in patients with pancreatic cancer: A systematic review and meta-analysis

Koulouris, Andreas; Alexandre, Leo; Hart, Andrew; Clark, Allan

doi:10.1016/j.pan.2020.12.016

Cited by 34 publications

(29 citation statements)

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“…A recently published meta-analysis on EUSguided CPN in pancreatic cancer patients compared response rates at different time points post procedure and reported treatment response in 68% of the patients in week 2% and 53% of the patients at week 4. When comparing bilateral with central technique, it did not show a significant difference in treatment response at 2 weeks [32].…”

Section: Discussionmentioning

confidence: 75%

EUS-guided celiac plexus neurolysis for pain in pancreatic cancer patients – a meta-analysis and systematic review

Asif

Walayat

Bechtold

et al. 2021

Journal of Community Hospital Internal Medicine Perspectives

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Section: Discussionmentioning

confidence: 75%

EUS-guided celiac plexus neurolysis for pain in pancreatic cancer patients – a meta-analysis and systematic review

Asif

Walayat

Bechtold

et al. 2021

Journal of Community Hospital Internal Medicine Perspectives

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“…The notable benefit is supported by evidence from the 2 latest meta-analyses in 2021 [38,39]. Among them, Koulouris et al [38] demonstrated that 3 different methods of the CN, including central injection, bilateral injection, and CGN, showed no difference in the efficacy of the pain management. However, very little information on the effects of this intervention on OS of pancreatic cancer patients is currently available, and the results are controversial.…”

Section: Discussionmentioning

confidence: 97%

“…Two independent meta-analyses separately indicated that EUS-guided CN can offer around 80% pain relief in pancreatic cancer patients [36,37]. The notable benefit is supported by evidence from the 2 latest meta-analyses in 2021 [38,39]. Among them, Koulouris et al [38] demonstrated that 3 different methods of the CN, including central injection, bilateral injection, and CGN, showed no difference in the efficacy of the pain management.…”

Section: Discussionmentioning

confidence: 98%

The Effect of Celiac Neurolysis and Splanchnicectomy on Survival in Unresectable Pancreatic Cancer: A Systematic Review and Meta-Analysis

Schorn

Pergolini

et al. 2021

Dig Surg

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Background: Intractable pancreatic pain is one of the most common symptoms of patients with pancreatic ductal adenocarcinoma (PDAC). Celiac neurolysis (CN) and splanchnicectomy were already described as effective methods to manage abdominal pain in unresectable PDAC, but their impact on overall survival (OS) has not yet been established. Objective: We aimed to investigate the impact of CN and splanchnicectomy on the survival of patients with unresectable pancreatic cancer. Methods: A systematic review of PubMed and Cochrane Library according to predefined searching terms was conducted in March 2020. Hazard ratios (HR) of OS data were calculated using the Mantel-Haenszel model for random effects or fixed effects. Result: Four randomized-controlled trials (RCTs) and 2 non-RCTs with a total of 2,507 patients were identified. The overall pooled HR did not reveal any relevant effect of CN and splanchnicectomy on OS (HR: 1.03; 95% CI: 0.81–1.32), which was also underlined by the sensitivity analysis of RCTs (HR: 1.0; 95% CI: 0.72–1.39) and non-RCTs (HR: 1.07; 95% CI: 0.71–1.63). However, subgroup analyses depending on tumor stage revealed that CN or splanchnicectomy was associated with a worsened OS in AJCC (American Joint Committee on Cancer) stage III patients with unresectable PDAC (HR: 1.22; 95% CI: 1.03–1.45), but nor for AJCC stage IV patients (HR: 1.27; 95% CI: 0.9–1.80). Conclusion: Although only few data are currently available, this systematic review with meta-analysis showed that in unresectable PDAC, CN or splanchnicectomy is associated with a worsened survival in stage III PDAC patients, with no effect on stage IV PDAC patients. These data call for caution in the usage of CN or splanchnicectomy in stage III PDAC and for further studies addressing this observation.

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“…The combination of an EUS-CPN plus analgesic opioids could be superior to opioid therapy alone[ 7 ]. However, this should be demonstrated in randomized clinical trials (RCTs) to further validate these findings[ 26 , 28 ].…”

Section: Efficacy Of Cpnmentioning

confidence: 99%

“…Recently, Koulouris et al [ 28 ] performed a systematic review and meta-analysis on the efficacy of three EUS-CPN techniques on pain control: central, bilateral and ganglia injection. Pain control was achieved in 68% of the patients at week 2 and 53% of the patients at 4 wk of follow-up.…”

Section: Ganglia Injectionmentioning

confidence: 99%

Endoscopic ultrasonography-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer: An update

Pérez-Aguado¹,

Mata²,

Valenciano³

et al. 2021

WJGE

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Pancreatic cancer produces disabling abdominal pain, and the pain medical management for pancreatic cancer is often challenging because it mainly relies on the use of narcotics (major opioids). However, opioids often provide suboptimal pain relief, and the use of opioids can lead to patient tolerance and several side effects that considerably reduce the quality of life of pancreatic cancer patients. Endosonography-guided celiac plexus neurolysis (EUS-CPN) is an alternative for pain control in patients with nonsurgical pancreatic cancer; EUS-CPN consists of the injection of alcohol and a local anesthetic into the area of the celiac plexus to achieve chemical ablation of the nerve tissue. EUS-CPN via the transgastric approach is a safer and more accessible technique than the percutaneous approach. We have reviewed most of the studies that evaluate the efficacy of EUS-CPN and that have compared the different approaches that have been performed by endosonographers. The efficacy of EUS-CPN varies from 50% to 94% in the different studies, and EUS-CPN has a pain relief duration of 4–8 wk. Several factors are involved in its efficacy, such as the onset of pain, previous use of chemotherapy, presence of metastatic disease, EUS-CPN technique, type of needle or neurolytic agent used, etc. According to this review, injection into the ganglia may be the best technique, and a good visualization of the ganglia is the best predictor for a good EUS-CPN response, although more studies are needed. However, any of the 4 different techniques could be used to perform EUS-CPN effectively with no differences in terms of complications between the techniques, but more studies are needed. The effect of EUS-CPN on pain improvement, patient survival and patient quality of life should be evaluated in well-designed randomized clinical trials. Further research also needs to be performed to clarify the best time frame in performing a EUS-CPN.

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Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) technique and analgesic efficacy in patients with pancreatic cancer: A systematic review and meta-analysis

Cited by 34 publications

References 50 publications

EUS-guided celiac plexus neurolysis for pain in pancreatic cancer patients – a meta-analysis and systematic review

EUS-guided celiac plexus neurolysis for pain in pancreatic cancer patients – a meta-analysis and systematic review

The Effect of Celiac Neurolysis and Splanchnicectomy on Survival in Unresectable Pancreatic Cancer: A Systematic Review and Meta-Analysis

Endoscopic ultrasonography-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer: An update

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